One of my blog followers asked if I could describe the differences between Bipolar type 1 and Bipolar type 2 disorders, the most common disorders on what is a bipolar spectrum of disorders. I thought about how I would approach such an article considering the extreme number of articles on this subject online and in books. With only a few exceptions, most of these articles look about the same. They basically say the following:
Bipolar type 1 must include at least one full blown manic episode not attributable to certain drug use or other illness, diagnosed by a healthcare professional qualified to diagnose mental illnesses. It may also be preceded or followed by hypomanic (a milder form of mania) or major depressive episode(s). The latter two are usually always experienced at some point, but are not mandatory for the Bipolar type 1 diagnosis.
Bipolar type 2 must include at least one current or past hypomanic episode (milder form of mania) not attributable to certain drug use or other illness, AND a current or past major depressive episode. People with Bipolar type 2, must have experienced both types of episodes for diagnosis of the disorder (unlike people with Bipolar type 1), and have received the diagnosis from a healthcare professional qualified to diagnose mental illnesses.
For the diagnosis of bipolar episodes, there are minimum episode lengths, minimum number of symptoms required and total criteria that need to be met. These vary by episode type. Symptoms for full blown mania and hypomania are mostly exactly the same. So you may ask “If the symptoms are pretty much the same for full blown mania and hypomania, what makes them one vs. the other?” The answer is a matter of degree of severity of the symptoms. A doctor qualified to diagnose mania vs. hypomania will make that determination. Factors such as whether the mania was severe enough for hospitalization or major life disruption may also play a part.
To see an informal list of symptoms for mania, hypomania and major depression see the National Institute of Mental Health’s bipolar episode symptom list.
I mentioned “flavors” of bipolar disorder in my blog post title. I did so because not every person with Bipolar type 1 experiences the illness exactly the same, and ditto for people with Bipolar type 2. Some people afflicted will not experience all of the same symptoms as others, or sometimes individual episodes include different sets of symptoms. Some people experience episodes more rapidly than others (“rapid cycling”), on the whole, or at times. Some people are prone to what is called “mixed features”, where an episode combines manic or hypomanic symptoms with major depressive symptoms at the same time. In the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), there are several specifiers (like “with mixed features” or “with rapid cycling”) that provide more details on possible extra characteristics of episodes. A couple of others that are common include “with anxious distress” or “with mood-congruent (or mood-incongruent) psychotic features”. These characteristics are possible in either type of bipolar disorder, with the psychotic features generally only during some depressions in Bipolar type 2. Pure mania or hypomania may not always be elated. Sometimes they can be quite irritable (even to the point of aggression), or a combination of the two.
Some people with either bipolar type may be hospitalized several times throughout their lives, others never. The impact on a given person’s life may vary greatly, too. Though some people may think that Bipolar type 2 is a milder version of the illness, that may not be the case. Some people with Bipolar type 2 experience depressions far more severe and disabling than the full blown manias or depressions of people with Bipolar type 1. Again, other times not. Also, according to a 2002 study by Lewis L. Judd et al. published in the Archives of General Psychiatry, on average, people with Bipolar type 2 experience the whopping ratio of time in depression to hypomania as 40:1, while people with Bipolar type 1 on average experience time in depression to full blown mania as 3:1
People with both disorders may sometimes only experience low grade depressions that affect their lives in minor ways. Others may experience depressions so severe that they cannot perform their job, move from their bed, suffer psychosis, be of harm to themselves or possibly commit suicide, and/or require hospitalization. One can have mild, moderate and/or severe depressions at some point(s) during their life. How many of what severity varies. Often people slowly experience all levels as they fall into or pull out of this state.
Like the depressions I mentioned above, hypomania can be mild to the point where symptoms are exhibited, but daily life can easily continue. However, to qualify for a hypomanic episode, a person’s behavior must show an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic, and be observable by others. Moderate hypomania would be particularly uncharacteristic of the person, but still not severe enough to cause significant impairment in social or occupational functioning, or to necessitate hospitalization, unless severe enough mixed features are present.
All pure full blown manic episodes are severe enough to cause marked impaired social or occupational functioning, and may necessitate hospitalization to prevent harm to self or others. Some full blown manias may also include psychotic features. Full blown manias can affect a person’s life in terribly negative ways. Examples may include job loss, marriage ruin (perhaps from adultery), financial ruin, arrest, harm to self or others, and commitment into a hospital. Or even if a full blown manic person avoids such extreme tragedies, generally some price is usually paid, even if it equated to buying 10 snake bite kits you didn’t need, embarrassing yourself in public, shaving your head, or getting a tattoo you’d normally never get.
Both types of bipolar disorder are serious diagnosable mental illnesses. Bipolar disorder is not a negative personality trait. Both are considered to be mood disorders. There is still a lot of stigma attached to bipolar disorder (both types) and other mental illnesses, including diagnosable personality disorders. Stigma is unfair and generally based on lack of knowledge. When a person flippantly refers to a workmate, friend or acquaintance as “bipolar” without actual knowledge of their having a diagnosed mental illness, it lessens the seriousness of the struggle faced by those who truly experience significant mood elevation and depression. At the same time, using unkind labels like “nut job”, “loony”, and the like, are cruel. One would usually never treat someone with heart disease or breast cancer in such a manner.
If anyone has any questions or comments about this post, please feel free to share them.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013